47 Methods: This study was conducted via qualitative interviews and took on a phenomenological, hermeneutic approach involving semi-structured interviews. Eleven head and neck cancer patients were interviewed one month post radiation. Results: This study showed that radiation therapists have a significant influence on head and neck cancer patients’ distress. Many patients felt claustrophobia associated with treatment. They felt that the treatment was easier to undergo when the same radiation therapist gave treatment every day, when they reassured them by putting a hand on their shoulder or arm, and when they completed the treatment quickly. In addition, patients appreciate that radiation therapists reassured them with words. 15.22. A Review of 10 Years of Advanced Practice … An Evidence-Based Approach to Revolutionize Practice Presenter: Marcia Smoke, Juravinski Cancer Centre, Hamilton, Ontario, Canada Authors: Marcia Smoke (Juravinski Cancer Centre, Hamilton, Ontario, Canada) and Donna Lewis (Odette Cancer Centre, Toronto, Ontario, Canada) Introduction: In Ontario, Canada, a mandate was established to create advanced practice roles for radiation therapists. Over the last 10 years, this initiative has revolutionized the profession of radiation therapy. A 2003 Symposium, entitled Improving the Present – Embracing the Future, featured experts on advanced practice from the UK, professional associations, education and legislation. This Symposium was the beginning of a literature review which focused the initiative to potential roles. A further comprehensive literature review was performed. The project initiated with government funding for 5 roles and has expanded to 17 advanced practice positions. The evidenced-based approach to developing, implementing and evaluating advanced practice roles will be presented. The quality framework "Plan, Do, Study, Act" (PDSA) provided the basis for the implementation, assessment and evolution of the advanced positions. Since suitable Master’s level candidates were not available, a Prior Learning and Assessment Recognition (PLAR) process was developed to determine candidate selection. The metrics used to validate the roles included competency assessment, consensus/concordance studies, safety data, stakeholder satisfaction, burnout, and wait time data. At the national level, the professional association performed a validation survey to determine the competency profile for advanced practitioners. The formalized national “validation process” formed a consensus document describing advanced practice in radiation therapy. Also, at the national level a certification and credentialing process for advanced practitioners was developed. Methods: The Quality Framework "Plan, Do, Study, Act" was used to develop, implement and assess advanced positions. Validation metrics included competency assessment, consensus/concordance studies, patient/stakeholder satisfaction, burnout and wait time data. Results: This revolutionizing evidence-based initiative demonstrated that advanced practitioners can improve quality, effectiveness and access to existing systems and processes and can add new services to patients in those systems. Patients are highly satisfied with the care they received and advanced practitioners are valued members of the teams, facilitating improved workflow and enhanced team functioning. Government funding has been secured for additional advanced practice positions. 15.23. Multimodality Imaging In Radiotherapy At Rgci& Rc India Presenter: Gurvinder Singh Wadhawan, Rajiv Gandhi Cancer Institute & Research Centre, India Author: Gurvinder Wadhawan Introduction: Accurate image guided radiotherapy (IGRT) using MVCBCT is essential prerequisite to practice IMRT or 3DCRT and forms an important factor in the quality of actual radiation delivery. The capability of generating an entire volumetric MV-CBCT data set in a single-gantry rotation, allows 3D visualization of the tumor prior to the delivery of treatment and correlation with reference plan CT data. This permits corrections of shifts beyond an acceptable limit. Methods: Prior to treatment, 2D and/or CBCT (on ARTISTE Siemens and Varian ix)was acquired and setup errors with reference to X, Y, Z were corrected online in 20 patients of breast, head & neck (H&N) and prostate. A second CBCT was acquired after the correction process and coordinates for daily set-up and images were obtained. Results: A total number of 211 CBCT/ or 2D images were performed in 20 patients. The sites included – breast (n=10), H&N (n=6) and prostate (n=4). Images were evaluated for 95, 58 and 58 fractions respectively. The shifts observed in X, Y and Z axes are summarized below: In addition, rotational errors were observed in 7% (15/211 images). These include breast (2%),H&N (1%) and prostate (4%), which were also corrected by IGRT. Despite immobilization devices, shifts beyond the acceptable limits of 2mm were observed during online CBCT or 2D imaging with IGRT in breast (79.9%), H&N (49.2%) and prostate (96.6%). IGRT permits detection and online corrections of these shifts which would have been otherwise gone unnoticed leading to dosimetric errors during radiation therapy. 16. RESEARCH 16.1. Interdisciplinary practice within the MRS profession Presenter: Madeleine Shanahan, RMIT University, Australia Author: Madeleine Shanahan Introduction: Interprofessional practice (IPP) or terms used interchangeably such as interdisciplinary practice to describe the delivery of health care by a diverse team of health professionals (HPs) is of increasing interest to health educators, practitioners and policy makers around the globe. IPP and multidisciplinary teams (MDT) operating within healthcare are said to optimise the skills of their members and provide better health-services to patients and the community. However, little is currently known about IPP applications in the Medical Radiation Science (MRS) profession. Ultimately we need information about where IPP is used within and across the MRS profession and identify issues that may currently limit IPP within the MRS profession. Methods: This study used online survey method to collect data on IPP within the MRS profession. Participation in the survey was N=332. Results: MRS professionals work collaboratively with medical practitioners (91%), their own area of specialisation (AoS) (89%), other HPs (73%), other AoS within MRS (70%), medical physicists (49%) and participate in MDT meetings (43%) to support high quality health care. However as MRS professionals have a lower level of confidence working with those outside their own AoS, and some have limited or no access to other HPs, additional access and support is needed so MRS can more fully participate in IPP. 16.2. Decision making in diagnostic imaging investigations: a case study of processes and interactions between patients and health care professionals Presenter: Chandra Rekha, University of Pretoria, South Africa Author: CR Makanjee Introduction: The use of diagnostic medical imaging can be defined as “timely access to and delivery of inte¬grated and appropriate radiological studies and interventions in a safe and responsive facility and a prompt delivery of accurately interpreted reports by capable personnel in an efficient, effective, and sustainable manner” (Pitman et al., 2009: 457). According to Ber¬nardy et al. (2009: 844), the quality of medical care brings value to both patient and provider when medical imaging is justified and is performed correctly. Despite the acknowledgement in the current literature that health professional-patient interactions and decisionmaking processes regarding referral, diagnostic imaging investigations, interpretation and communication of outcomes are complex phenomena, research in diagnostic investigations in general has been fragmented (Geneau et al., 2008: 10). These fragmented studies focus on test ordering (Geneau et al., 2008: 8; Whiting et al., 2007), cost (Olivier et al., 2005: S83; Hof¬mann and Lydsdahl, 2008: 446; Hendee et al., 2010: 240), and overutilisation of diagnostic services (e.g. as a result of new technology, officebased imaging, physician self-referral, increasing patient demands, altered reimbursement systems, commercial liability, and fear of lawsuits). This study was an attempt to bridge the gap of fragmentation and to embrace the shift from a technology-centred approach to an integrated patientcentred approach (Ugwu et al., 2009: 1; Halkett, 2011: 55). The main aim of this study was to get an understanding of the various decision-making processes involved in referral for and the choice of the most appropriate diagnostic imaging investigation.
ISRRT | Book Of Abstracts
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